Epidemiological characteristics, management, and outcomes of atrial fibrillation in TUNISIA: Results from the National Tunisian Registry of Atrial Fibrillation (NATURE-AF).

BACKGROUND: Contemporary registries on atrial fibrillation (AF) are scare in North African countries. HYPOTHESIS: In the context of the epidemiological transition, prevalence of valvular AF in Tunisia has decreased and the quality of management is still suboptimal. METHODS: NATURE-AF is a prospective Tunisian registry, involving consecutive patients with AF from March 1, 2017 to May 31, 2017, with a one-year follow-up period. All the patients with an Electrocardiogram-documented AF, confirmed in the year prior to enrolment were eligible. The epidemiological characteristics and outcomes were described. RESULTS: A total of 915 patients were included in this study, with a mean age of 64.3 ± 22 years and a male/female sex ratio of 0.93. Valvular AF was identified in 22.4% of the patients. The mean CHA2 DS2 VASC score in nonvalvular AF was 2.4 ± 1.6. Monotherapy with antiplatelet agents was prescribed for 13.8% of the patients. However, 21.7% of the subjects did not receive any antithrombotic agent. Oral anticoagulants were prescribed for half of the patients with a low embolic risk score. In 341 patients, the mean time in therapeutic range was 48.87 ± 28.69%. Amiodarone was the most common antiarrhythmic agent used (52.6%). During a 12-month follow-up period, 15 patients (1.64%) had thromboembolism, 53 patients (5.8%) had major hemorrhage, and 52 patients (5.7%) died. CONCLUSIONS: NATURE-AF has provided systematic collection of contemporary data regarding the epidemiological and clinical characteristics as well as the management of AF by cardiologists in Tunisia. Valvular AF is still prevalent and the quality of anticoagulation was suboptimal.

Unusual cause of syncope in a 17 year-old young woman: left ventricular hydatid cyst.

Cardiac involvement in echinococcosis remains a singular finding, possibly associated with confusing symptomatology. We report the original case of a 17 year-old young woman, referred to our cardiology department for repeated exertion syncopes, and ultimately, proven through echocardiography, serologies and magnetic resonance imaging to have a massive hydatid cyst developing inside the left ventricular cavity towards the outflow tract. The cyst has been surgically completely removed with excellent results.

Total absence of ST-segment resolution after failed thrombolysis is correlated with unfavorable short- and long-term outcomes despite successful rescue angioplasty.

INTRODUCTION: ST-segment resolution (STR) is a well-established and simple tool for assessing the efficacy of reperfusion therapy in myocardial infarction. An incomplete (<50%) STR is a recognized marker of failed thrombolysis and a suitable recruitment criterion for rescue angioplasty. OBJECTIVE: We sought to determine the predictive value of the total absence of STR after thrombolysis in rescue angioplasty (percutaneous coronary intervention [PCI]). METHODS: Eighty-one consecutive patients who underwent a rescue angioplasty for failed thrombolysis in our institution from 2001 to 2007 were included. Two groups of patients were defined according to their STR extent, 90 minutes after lysis: partial resolution group 1 (10%-50% STR) vs absence of resolution group 2 (<10% STR) and compared in terms of in-hospital and long-term outcomes. RESULTS: Patients of group 2 were more likely to experience hemodynamic deterioration (50% vs 24%; odds ratio [OR] = 3.17; P = .017), to have a Thrombolysis in Myocardial Infarction 0 flow on the culprit artery (62.3% vs 42%; OR = 2.24; P = .045), to have a multivessel disease (66.7% vs 40%; OR = 3; P = .018), and to die during index hospitalization (26.7% vs 6%; OR = 5.69; P = .013) despite statistically similar rates of PCI failure in both groups (10% vs 7%; P = .402) and similar post-PCI STR (72% +/- 18.25% vs 75% +/- 11.62%; P = .36). In multivariate analysis, total absence of STR proved to be an independent predictor of in-hospital mortality (HR = 7.02; P = .032; 95% confidence interval, 1.18-41.58). Long-term major adverse cardiac events occurred more frequently in group 2 (log rank, P = .004) and were (on the Cox regression model) independently predicted by total absence of STR (HR = 6.21; P = .023; 95% confidence interval, 1.28-29.1). CONCLUSIONS: The STR assessment before rescue PCI proved to be a good and simple means to predict the short- and long-term prognosis in these patients.

Rapid occurrence of giant left ventricular pseudoaneurysm after mitral valve replacement.

Left ventricular pseudoaneurysms are an uncommon and frightening complication after mitral valve replacement. We report the case of a 54-year old woman, having undergone a mitral valve replacement with uneventful postoperative course and normal echocardiographic predischarge control, who was readmitted to hospital, only 16 days later, for rapidly progressing dyspnea, and finally echocardiographically diagnosed to have a massive 8-cm long pseudoaneurysm communicating with the left ventricle through a narrow communication. The patient was proposed for emergency surgery but unfortunately died preoperatively.

Left main coronary thrombosis: unusual complication after radiofrequency ablation of left accessory atrioventricular pathway.

Radiofrequency ablation (RFA) has established itself as a first-line therapy for the curative treatment of many patients with supraventricular or atrioventricular tachycardias and has exhibited a generally low incidence of serious sequelae (N Engl J Med. 1991;324:1612; Lancet. 1991;337:1557). Coronary artery injury is a rare complication. We present a patient with an acute thrombotic total occlusion of the left main coronary artery immediately after the end of RFA who was successfully treated with emergency percutaneous transluminal coronary angioplasty. This case illustrates an unusual coronary complication of RFA and serves as an exceptional example of survival with a good short-term prognosis after this unusual etiology of myocardial infarction.

Neurogenic pulmonary edema due to traumatic brain injury: evidence of cardiac dysfunction.

BACKGROUND: Acute neurogenic pulmonary edema, a common and underdiagnosed clinical entity, can occur after virtually any form of injury of the central nervous system and is a potential early contributor to pulmonary dysfunction in patients with head injuries. OBJECTIVE: To explore myocardial function in patients with evident neurogenic pulmonary edema after traumatic head injury. METHODS: During a 1-year period in a university hospital in Sfax, Tunisia, information was collected prospectively on patients admitted to the 22-bed intensive care unit because of isolated traumatic head injury who had neurogenic pulmonary edema. Data included demographic information, vital signs, neurological status, physiological status, and laboratory findings. All of the patients had computed tomography and plain radiography of the neck and determination of cardiac function. RESULTS: All 7 patients in the sample had cardiac dysfunction. Evidence of myocardial damage was confirmed by echocardiography in 3 patients, pulmonary artery catheterization in 3 patients, and/or postmortem myocardial biopsy in 4 patients. Echocardiography studies, repeated 7 days after the initial study in one patient and 90 days afterward in another, showed complete improvement in wall motion, with a left ventricular ejection fraction of 0.65. CONCLUSION: All patients who had neurogenic pulmonary edema due to traumatic head injury had myocardial dysfunction. The mechanisms of the dysfunction were multiple. The great improvement in wall motion seen in 2 patients indicated the presence of a stunned myocardium. Further studies are needed to understand the mechanisms of this cardiac dysfunction.

[Short coupled variant of "torsades de pointes" and sudden death]. / Torsade de pointes a couplage court compliquee d'une mort subite.

A case report of 38 year old man who experienced syncope and torsade de pointes is presented with the short coupled variant. The patient had a normal QT interval (QTC: 0.37 seconds) and multiform ventricular premature beats on the resting electrocardiogram. Under antiarrhythmic treatment (intravenous xylocaine), torsades de pointes suddenly appeared and cardiac arrest was followed. After cardioversion, sinus rhythm was restored. A cardiovascular disease was excluded, the echocardiography, the left and right ventricular angiography and coronarography were normal. Three months after, the patient presented at home a sudden cardiac death.

[Use of an implantable defibrillator for the prevention of sudden death in hypertrophic cardiomyopathy]. / Cardiomyopathie hypertrophique: implantation d'un defibrillateur automatique implantable chez un patient a haut risque de mort subite.

Hypertrophic cardiomyopathy is an inherited muscle disorder disease. Sudden death is the most dreaded complication, risk stratification is of critical importance and patients with high risk should receive an implantable cardioverter defibrillator (ICD). We report the case of 26 years old man affected by a severe form of hypertrophic cardiomyopathy. Our patient falls into a high risk category because of his young age, massive left ventricular hypertrophy and family history of premature death due to hypertrophic cardiomyopathy. Considering his risk of dying sufficiently high, we proceed to percutaneous ICD under local anesthesia. Evolution was favorable after 3 months follow up.

[Radiofrequency ablation of periatriotomy atrial flutter after interatrial defect surgical repair]. / Ablation par radiofréquence d'un flutter auriculaire périatriotomie compliquant la réparation chirurgicale d'une communication inter-auriculaire.

We report a successful ablation of reentrant atrial tachycardia complicating atrial septal defect repair. This tachyarrhythmia was poorly tolerated hemodynamically and difficult to control with antiarrhythmic drug therapy and atrial pacing. Ablation therapy has focused on extending a line of block from the surgical incision to the inferior veno cava. Immediate success was achieved and the patient is free of arrhythmia after 4 months of Follow-up.